Resumen en español Se llevó a cabo un ensayo clínico para evaluar el riesgo químico en el laboratorio de análisis del Centro de Estudios de Biotecnología Industrial de la Facultad de Ciencias Naturales de la Universidad de Oriente, con vista a lo cual se identificaron, entre otros aspectos, las características generales del local y de las 20 técnicas establecidas para el análisis de aguas residuales y residuales agroindustriales (11 de estas se aplican 200 veces al año como promedi (mas) o), frecuencia de los análisis, reactivos químicos empleados y su categoría de peligro (fundamentalmente ácidos minerales, álcalis, solventes orgánicos y oxidantes fuertes), así como se evaluaron los riesgos químico-físicos y las medidas laborales de seguridad, incluido el tratamiento de los residuos antes de ser eliminados. Se observó que los analistas están expuestos a fuentes de calor y vapores de solventes y ácidos a través de la piel y el sistemarespiratorio, pero en un trienio solo se produjeron 3 accidentes leves y no hubo certificados médicos por enfermedades ocupacionales en este tipo de instalación. Resumen en inglés A clinical trial to evaluate the chemical risk was carried out at the analysis laboratory of the Industrial Biotechnology Studies Center in the Natural Sciences Faculty at Oriente University. For this purpose, aspects such as the general characteristics of the site and of the 20 established techniques for the analysis of waste waters and agroindustrial residual were identified, (11 of these were applied 200 times a year as average), frequency of the analyses, chemical rea (mas) gents used and their danger category (fundamentally mineral acids, alkalis, organic solvents and strong oxidizers), as well as the chemical-physical risks and the security working measures were evaluated, including the treatment of residuals before being eliminated. It was observed that the analysts are exposed to sources of heat and steam of solvents and acids through the skin and the respiratory system, but just 3 mild accidents took place in a triennium, and there were no medical certifications due to occupational diseases in this type of facility.

Resumen en español En Colombia la globalización ha generado un impacto negativo en el desarrollo científico y en la formación de nuevos profesionales con políticas que limitan derechos sociales como la salud, la educación y la cultura. La formación de profesionales de la salud en el país ha entrado en la lógica del mercado. Para reconocer estas debilidades se propusieron cinco conversatorios con propuestas formuladas con anterioridad dirigidas a los invitados, sobre elementos y crit (mas) erios en la formación académica. El diálogo fue conducido por la Universidad con diversos representantes externos: servicio de salud, asociaciones científicas, gremios. El grupo coordinador Red Salud elaboró las proposiciones a partir de identificar tres grandes ámbitos en los cuales han ocurrido cambios profundos en la dinámica mundial de salud: a) en la situación de salud de las poblaciones y sus determinantes; b) en el tipo de respuesta social de los estados y las sociedades a dicha situación; y c) en la producción y reproducción de saberes y prácticas del campo de la salud. Se identificaron como principales problemas de salud: los tradicionales, enfermedades infecciosas, crónicas y homicidios; la exclusión persistente de poblaciones vulnerables; las múltiples violencias; problemas antes parcialmente controlados como la malaria, el dengue, la tuberculosis, enfermedades diarreicas y respiratorias agudas y las de transmisión sexual; y problemas delSistema de Seguridad Social. En el ámbito universitario el reconocimiento de fallas profundas en el modelo pedagógico actual; algo común a las facultades tradicionales de las áreas de la salud es la existencia de tres tendencias de desarrollo, con escenarios, recursos e impactos diferentes. Se concluye que "es reconocido que la Universidad, ha hecho aportes, pero también reconocer que nos hemos quedado cortos; hemos estado más dedicados a formar profesionales que a la creación de modelos; a participar en debates que a reconocer problemas; a intensificar la investigación sobre la problemática nacional en el campo de la salud pública, que a participar en la formulación de propuestas y a partir de estas propuestas estimular discusiones y participar en los grandes debates nacionales para la construcción de la salud al servicio de la paz. Esta es la tarea fundamental de la Universidad Nacional Pública en este momento en el país". Resumen en inglés Summary In Colombia, the globalization has generated a negative impact on the scientific development and the formation of new professionals, with the application of policies that limit social rights such as health, education and culture. The formation of health professionals in the country has entered into the market logic. To show these weaknesses, five talks were suggested to present previously formulated proposals on elements and criteria in the academic formation aime (mas) d at the guests. The coordinating group called Red Salud prepared the proposals taking as a basis three large contexts in which great changes in the world health dynamics have occurred: a) health situation of the populations and their determinants; b) type of social response on the part of states and societies to this situation; and c) the production and reproduction of knowledge and practice in the field of health. The main identified health problems were: the traditional problems, infective and chronic diseases and homicides; the persistent exclusion of vulnerable populations; multiple violence; problems which were partially controlled before such as malaria, dengue, tuberculosis, diarrheas, acute respiratory and sexually transmitted diseases and problems in the Social Security system. In the university context, the recognition of big failures in the present teaching model, something that the traditional health faculties have in common, is the existence of three development tendencies with various scenarios, resources and impact. It is concluded that "it is admitted that the University has made contributions, however, it is also admitted that we did not go far enough, we have been more devoted to form professionals than to create models; more devoted to participate in debates than to identify problems, to intensify research on the national problems in the field of public health than to participate in the formulation of proposals, and based on these proposals, to stimulate analysis and participate in extensive national debates for the promotion of health at the service of peace. This is the fundamental task of the National Public University in the country at present."

Resumen en inglés Background: The relationship between air pollution and health damage has been sufficiently documented. In station "R" of the air quality monitoring system, located in a community of Metropolitan Santiago (Cerro Navia), the Chilean standard of 150 µg/m³, averaged in 24 hours, for particles with a diameter of 10 micrometers or less (PM10), has been exceeded more days than in the rest of the city stations. Aim: To investigate if the population living near that station has (mas) a higher proportion of lower respiratory infections than the Metropolitan Region (MR) as a whole. Material and methods: An outpatient clinic located near station "R" (Centro Albertz), was implemented as a sentinel center according to UNICEF methodology, used since 1992 by the Acute Respiratory Infections National Program. Daily information was collected between May and December 2004. Monitoring data included total number of consults by children less than 15 years old for lower respiratory tract infections, pneumonia, obstructive bronchitis syndrome in children and by adults over 64 years old for lower airway disease, chronic obstructive pulmonary disease (COPD), and pneumonia. Results were compared with those of the rest of MR. Results: Compared with the MR, children from the sentinel clinic had a significantly higher proportion of consults for obstructive bronchial syndrome (20.1% and 26.4% respectively, in p

Resumen en español El consumo de tabaco es un problema de salud pública en el mundo y se le ha asociado con diferentes tipos de cáncer, enfermedades cardiovasculares, enfermedades respiratorias, alteraciones en el sistema reproductivo, problemas dentales, úlcera péptica y algunas enfermedades de los ojos. De acuerdo con la Encuesta Nacional de Adicciones de 2002, en México fuman 26.4% de las personas entre 12 y 65 años de la población urbana y 14.3% de la población rural. En este se (mas) ntido, la Secretaría de Salud señala que en México fallecen anualmente más de 53 mil personas por enfermedades relacionadas con el consumo de tabaco, lo que lo ubica entre los diez primeros lugares de morbilidad y mortalidad. Entre los tratamientos propuestos para dejar de fumar se identifican las terapias sustitutivas con nicotina, las terapias farmacológicas, los tratamientos psicológicos y combinaciones de ellos. En relación con los tratamientos psicológicos, existe evidencia empírica que muestra la efectividad de las técnicas conductuales y cognitivo-conductuales para dejar de fumar. En México, se emplean tratamientos psicológicos y farmacológicos (nicotínicos y no nicotínicos) en personas que desean dejar de fumar. Sin embargo, en dichas intervenciones no se reportan datos específicos de los cambios en el patrón de consumo después de la aplicación de dichas intervenciones y si éste se mantiene a lo largo del tiempo. Asimismo, se sabe específicamente poco de la efectividad de las intervenciones breves dirigidas a fumadores en la población mexicana. Por lo tanto, en la presente investigación se evalúa un programa de intervención breve motivacional para fumadores que incide en el patrón de consumo de cigarros, en la percepción de la autoeficacia de los usuarios al finalizar la aplicación del programa y en el seguimiento a los seis meses. Para cumplir con el propósito se aplicó el programa de intervención breve motivacional a 10 personas de entre 19 y 55 años de edad que deseaban dejar de fumar. La evaluación del programa se realizó a partir de la comparación del patrón de consumo antes, durante y después de la aplicación de la intervención breve, así como del nivel de autoeficacia antes y después de la aplicación de la intervención breve. Un análisis de varianza (ANOVA) de medidas repetidas mostró cambios significativos en el patrón de consumo entre la línea base, intervención y seguimiento (F[2,18]=53.10, p Resumen en inglés Tobacco consumption is a world-wide public health problem that has been associated with different types of cancer, cardiovascular and respiratory diseases, alterations in the reproductive system, dental problems and some eye diseases. In Mexico the National Survey of Addictions (2002) reported that 26.4% of the urban population between 12 and 65 years and 14.3% of the rural population are smokers. The Secretary of Health indicated that more than 53000 people died from dis (mas) eases related to tobacco consumption. The consumption of tobacco stands among the ten first causes of morbidity and mortality in Mexico. In this sense, smoking is considered as one of the main public health problems in Mexico. Several organisms and institutions have undertaken actions in an attempt to solve it, such as the development of educative programs directed to the general population and programs to help smokers to quit this habit. Some of the main strategies to reduce cigarette consumption include nicotine replacement therapy, therapy not based on nicotine (antidepressants, some opiate antagonists and anxiolytic drugs), psychological programs, and the combination of some of them. Regarding psychological treatments, behavioral and cognitive behavioral techniques for smoking cessation hold empirical evidence about their efficacy for reducing the abuse of substances. In Mexico, psychological, nicotinic and non-nicotinic treatments to stop smoking are used. Nevertheless, the methodological and theoretical grounds of the psychological interventions are not well-established and there are no specific data about the changes in the consumption pattern after the application of the interventions and whether the effects of the treatment stay through the time. Specifically, the information about the efficacy of the brief interventions on smokers in the Mexican population is scarce. Although different studies have demonstrated that the brief motivational interventions are more effective to reduce the abuse of different substances than intensive interventions or no interventions at all, the techniques are not widely used in the treatment of tobacco consumption in Mexican population. With this evidence, the National Autonomous University of Mexico (UNAM) developed the Brief Motivational Intervention Program to treat smokers. The Brief Motivational Intervention is based in the Social Cognitive Theory, the Prevention of Relapses Model, in techniques of motivational interview and self-control techniques. Therefore, the goal of the present research is to evaluate a brief motivational intervention program for smokers. In order to achieve this aim, 10 individuals between 19 and 55 years old participated in the program; five individuals showed low nicotine dependence and five severe nicotine dependence according to the Questionnaire of Fagerström Tolerance. There was a public invitation and the participants consent to participate voluntarily in the > belonging to the Psychology Department, UNAM. The motivational brief intervention program for smokers consists of six sessions: an admission session, an evaluation session and four treatment sessions of one hour each. All of them were carried out individually based on the following theoretical and methodological components: social cognitive theory, techniques of motivational interview, techniques of self control and prevention of relapses model. The program was evaluated doing a comparison of the consumption pattern during and after the application of the brief intervention, and contrasting the level of self-efficacy before and after the application of the brief intervention. An analysis of variance (ANOVA) of repeated measures showed significant changes in the pattern of consumption (F [2, 18] =53.10,p

Resumen en inglés Background: Intensive medicine is especially expensive and requires an efficient management. Aim: To measure the real costs of diseases treated in an intensive care unit and compare them with the costs assigned by the Chilean National Health Fund (FONASA) for 2008. Material and Methods: Retrospective review of 225 patients, representing 82% of discharges from an intensive care unit during 2008. Patients were classified according to their medical conditions as having sepsi (mas) s, trauma, cardiovascular, respiratory or neurological diseases. Costs were calculated using the cost per activity system. Results: Trauma, sepsis and cardiovascular diseases had the greatest cost per inpatient day, corresponding to 294,779; 253,513 and 244,713 Chilean pesos, respectively. Seventy percent of costs correspond to human resources followed by complementary examinations, that represent up to 15% of costs. Patients with sepsis and cardiovascular diseases absorbed 28 and 26% of intensive care unit resources, respectively. Patients who died with these diseases absorbed 35 and 16% of resources, respectively. Conclusions: All diseases studied had significantly higher costs than those assigned by the National Health Fund

Resumen en español FUNDAMENTOS: La mayoría de los estudios que muestran la existencia de una asociación a corto plazo entre contaminación atmosférica y morbimortalidad, analizan los efectos de los contaminantes clásicos cuya fuente es la combustión. Sin embargo, los cambios en las fuentes de emisión, fundamentalmente hacia el tráfico rodado, han modificado la contaminación atmosférica, haciendo más importante los componentes foto-químicos, como el ozono (O3) y el di� (mas) �xido de nitrógeno (NO2). Barcelona es una ciudad situada en una zona templada y su contaminación atmosférica proviene principalmente de las emisiones de los vehículos. El principal objetivo de este artículo es el de analizar la relación entre los contaminantes foto-químicos, NO2 y O3, y la mortalidad por diferentes causas, en la ciudad de Barcelona desde 1991 hasta 1995, utilizando el protocolo de análisis elaborado dentro del proyecto EMECAM. MÉTODOS: Variaciones diarias del número de muertes por todas las causas, del número de muertes por todas las causas entre mayores de 70 años, del número de muertes por causas del aparato circulatorio y por causas respiratorias se relacionan con las variaciones diarias de los contaminantes foto-químicos, a través de modelos de Poisson autoregresivos, controlando confusores como la temperatura, la humedad relativa, la estructura temporal sistemática y la estructura autoregresiva. RESULTADOS: Excepto la relación entre O3 y mortalidad a causa de enfermedades respiratorias, las relaciones entre contaminantes foto-químicos y mortalidad por todas las causas consideradas resultaron estadísticamente significativas. Los riesgos relativos de morir ante incrementos de O3 fueron mayores que ante incrementos de NO2, casi el triple entre enfermedadesdel aparato circulatorio. Los riesgos relativos de morir por todas las causas son menores que por causas específicas y que para aquellos individuos mayores de 70 años. Los resultados del análisis por semestres son muy similares a los del global mostrando, en todo caso, riesgos relativos algo mayores en los meses cálidos (mayo a octubre). CONCLUSIONES: La contaminación fotoquímica, sobre todo la causada por O3, representa un riesgo para la salud. En el caso del NO2 podría ocurrir que no fuese más que un indicador de las partículas suspendidas o de otros contaminantes cuyo origen es el tráfico urbano. Podría existir cierta modificación entre semestres de los efectos del O3 sobre la mortalidad por causas del aparato circulatorio. Resumen en inglés BACKGROUND: Most of the studies which demonstrate the existence of a short-term relationship between air pollution and morbidity and the death rate analyze the impact of "classic" pollutants which are by-products of combustion. However, the changes in the sources of these emissions, shifting basically toward road traffic, has made a change in air pollution, heightening the importance of the photochemical components, such as ozone (O3) and nitrogen dioxide (NO2). Barcelona (mas) is a city located in a mild climate zone, and its air pollution comes mainly from vehicle emissions. The main objective of this article is that of analyzing the relationship between the photochemical pollutants, NO2 and O3 and the death rate for different causes in the city of Barcelona throughout the 1991-1995 period, using the procedure for analysis set out as part of the EMECAM Project. METHODS: Daily changes in the number of deaths resulting from all causes, of the number of deaths for all causes of those over age 70, of the number of deaths resulting from circulatory system-related causes, and of the number of deaths resulting from respiratory-related causes are related to the daily changes in the photochemical pollutants using autoregressive Poisson models, controlling confusion-causing variables such as the temperature, the relative humidity, the systematic time structure and the autoregressive structure. RESULTS: Except for the relationship between O3 and the death rate for causes involving respiratory illnesses, the relationships between photochemical pollutants and the death rate for all the causes considered were statistically significant. The risks related to dying as a result of rises in O3 were greater than as a result of rises in NO2, almost triple among circulatory system diseases. The risks related to dying for all the causes are lower than for specific causes and than for those individuals over age 70. The results of the analysis by six-month periods are quite similar to the overall results, revealing, in any event, relative risks somewhat greater during the warm months (May to October). CONCLUSIONS: Photochemical pollution, especially that which is caused by O3, comprises a health risk. IN the case of NO2, this might not be more than an indicators of the suspended particles or of other pollutants stemming from city traffic. There may be a certain adjustment between six-month periods of the impact of O3 on the death rate for causes of the circulatory system.

Resumen en español FUNDAMENTOS: La mayoría de los estudios que muestran la existencia de una asociación a corto plazo entre contaminación atmosférica y morbimortalidad, analizan los efectos de los contaminantes clásicos cuya fuente es la combustión. Sin embargo, los cambios en las fuentes de emisión, fundamentalmente hacia el tráfico rodado, han modificado la contaminación atmosférica, haciendo más importante los componentes foto-químicos, como el ozono (O3) y el di� (mas) �xido de nitrógeno (NO2). Barcelona es una ciudad situada en una zona templada y su contaminación atmosférica proviene principalmente de las emisiones de los vehículos. El principal objetivo de este artículo es el de analizar la relación entre los contaminantes foto-químicos, NO2 y O3, y la mortalidad por diferentes causas, en la ciudad de Barcelona desde 1991 hasta 1995, utilizando el protocolo de análisis elaborado dentro del proyecto EMECAM. MÉTODOS: Variaciones diarias del número de muertes por todas las causas, del número de muertes por todas las causas entre mayores de 70 años, del número de muertes por causas del aparato circulatorio y por causas respiratorias se relacionan con las variaciones diarias de los contaminantes foto-químicos, a través de modelos de Poisson autoregresivos, controlando confusores como la temperatura, la humedad relativa, la estructura temporal sistemática y la estructura autoregresiva. RESULTADOS: Excepto la relación entre O3 y mortalidad a causa de enfermedades respiratorias, las relaciones entre contaminantes foto-químicos y mortalidad por todas las causas consideradas resultaron estadísticamente significativas. Los riesgos relativos de morir ante incrementos de O3 fueron mayores que ante incrementos de NO2, casi el triple entre enfermedadesdel aparato circulatorio. Los riesgos relativos de morir por todas las causas son menores que por causas específicas y que para aquellos individuos mayores de 70 años. Los resultados del análisis por semestres son muy similares a los del global mostrando, en todo caso, riesgos relativos algo mayores en los meses cálidos (mayo a octubre). CONCLUSIONES: La contaminación fotoquímica, sobre todo la causada por O3, representa un riesgo para la salud. En el caso del NO2 podría ocurrir que no fuese más que un indicador de las partículas suspendidas o de otros contaminantes cuyo origen es el tráfico urbano. Podría existir cierta modificación entre semestres de los efectos del O3 sobre la mortalidad por causas del aparato circulatorio. Resumen en inglés BACKGROUND: Most of the studies which demonstrate the existence of a short-term relationship between air pollution and morbidity and the death rate analyze the impact of "classic" pollutants which are by-products of combustion. However, the changes in the sources of these emissions, shifting basically toward road traffic, has made a change in air pollution, heightening the importance of the photochemical components, such as ozone (O3) and nitrogen dioxide (NO2). Barcelona (mas) is a city located in a mild climate zone, and its air pollution comes mainly from vehicle emissions. The main objective of this article is that of analyzing the relationship between the photochemical pollutants, NO2 and O3 and the death rate for different causes in the city of Barcelona throughout the 1991-1995 period, using the procedure for analysis set out as part of the EMECAM Project. METHODS: Daily changes in the number of deaths resulting from all causes, of the number of deaths for all causes of those over age 70, of the number of deaths resulting from circulatory system-related causes, and of the number of deaths resulting from respiratory-related causes are related to the daily changes in the photochemical pollutants using autoregressive Poisson models, controlling confusion-causing variables such as the temperature, the relative humidity, the systematic time structure and the autoregressive structure. RESULTS: Except for the relationship between O3 and the death rate for causes involving respiratory illnesses, the relationships between photochemical pollutants and the death rate for all the causes considered were statistically significant. The risks related to dying as a result of rises in O3 were greater than as a result of rises in NO2, almost triple among circulatory system diseases. The risks related to dying for all the causes are lower than for specific causes and than for those individuals over age 70. The results of the analysis by six-month periods are quite similar to the overall results, revealing, in any event, relative risks somewhat greater during the warm months (May to October). CONCLUSIONS: Photochemical pollution, especially that which is caused by O3, comprises a health risk. IN the case of NO2, this might not be more than an indicators of the suspended particles or of other pollutants stemming from city traffic. There may be a certain adjustment between six-month periods of the impact of O3 on the death rate for causes of the circulatory system.

Resumen en inglés The damaging effect of atmospheric pollution with particulate matter and toxic gases on the respiratory system and its effect in the incidence and severity of respiratory diseases, is well known. A similar effect on the cardiovascular system is currently under investigation. Epidemiological studies have demonstrated that the inhalation of particulate matter can increase cardiovascular disease incidence and mortality, specially ischemic heart disease. The damage would be m (mas) ediated by alterations in the autonomic nervous system, inflammation, infections and free radicals. In human studies, environmental pollution is associated with alterations in cardiac frequency variability and blood pressure and with changes in ventricular repolarization. Experimentally, an enhancement of ischemia, due to coronary obstruction, has been demonstrated. The study of the toxic effects of environmental pollution over the cardiovascualr system, is an open field, specially in Chile, were the big cities have serious contamination problems (Rev Méd Chile 2004; 132: 761-7)